This article examines the ethical and psychological consequences of Medicaid funding cuts through the integrated framework of hermeneutic medicine, Jewish mystical theology, and liberation medicine. Drawing on the kabbalistic concept of shevirat ha-kelim (shattering of the vessels), the dialectic of tzimtzum (divine contraction) and Shekhinah consciousness, and the author's published work on therapeutic presence and sacred listening, this study argues that contemporary healthcare policy represents not merely fiscal reallocation but a profound ontological rupture in the covenant between society and its most vulnerable members. The displacement of millions from continuous primary care relationships constitutes what we term a 'therapeutic exile'—a systematic displacement of patients from sacred healing spaces into the fragmented, episodic realm of emergency medicine. This exile generates cascading psychological trauma: the erosion of narrative continuity, the pathologization of poverty, the internalization of systemic abandonment, and the moral injury inflicted upon clinicians who witness but cannot prevent the suffering of the uninsured. Through synthesis of clinical experience, contemporary phenomenology, and ancient wisdom traditions, this article proposes a reconceptualization of healthcare access as a moral-theological imperative and offers frameworks for clinician resilience and advocacy grounded in the understanding that authentic healing emerges only where sacred presence meets human vulnerability.
Background: Telemedicine in Egypt has shown sustainability while opening a way for more engagement in healthcare. This systematic review examines the use of telemedicine and its impact on Egyptians, focusing on the limited internet accessibility in Egypt. Methods: An exhaustive search was conducted in the PubMed, MEDLINE, Scopus, Web of Science, and EMBASE databases, specifically in the years 2015–2024, to obtain valid articles. Studies were investigated within the framework of pre-designed inclusion criteria, which helped in the identification of 10 articles specific to the report. The JBI checklist was explored to improve the performance of these studies, and narrative synthesis was employed to compile the findings in textual form. Results: The analysis identified five main themes: telemedicine knowledge and attitudes, usage by the public and healthcare practitioners, implementation barriers, impact on patient care, and community led monitoring. Despite the Egyptian community having positive attitudes towards telemedicine, barriers such as technology limitations, data privacy concerns, and reliance on physical wards for diagnosis remain. Private hospitals are more equipped than government facilities, affecting implementation. While challenges exist, telemedicine has the potential to improve patient care by increasing convenience and reducing wait times. Conclusion: Telemedicine can enhance healthcare in Egypt by improving access and patient outcomes. However, success depends on overcoming obstacles such as policy development and institutional capacity. Policymakers must create governance standards, invest in infrastructure, and improve training.
Commercial sex work, while providing a source of livelihood and sexual gratification for those who engage in it, has significant negative impacts on public health. These impacts include increased vulnerability to sexually transmitted infections (STIs), unintended pregnancies, and broader health risks. Although factors such as poverty, peer pressure, and unemployment drive individuals into sex work in most parts of the world, including Nigeria, this practice remains illegal in Nigeria and many other countries globally. Therefore, understanding and designing appropriate interventional strategies, including job creation, skill acquisition programs, and widespread health education and awareness campaigns, will be useful in addressing this public health issue. These measures can contribute significantly to improving a country’s health indices and reducing the negative impact of commercial sex work on public health.
Borderline Personality Disorder (BPD) is a serious mental illness characterized by a chronic pattern of instability in interpersonal relationships and self-image, along with a higher baseline of emotional sensitivity and marked impulsivity that begins by early adulthood and persists regardless of context. Emotion dysregulation, a cardinal feature of the disorder, is of high relevance to clinical and medical contexts since it has been correlated with greater risk of parasuicidal behaviors, co-occurring psychiatric illnesses and multiple hospitalizations. Less understood is the role of emotion dysregulation on somatization and medical comorbidity. Physiological correlates of emotion dysregulation, such as decreased heart rate variability (HRV) and cascades of pro-inflammatory cytokines associated to dysphoric mood can increase the risk of medical comorbidity in the BPD population. This mini review assesses and discusses how maladaptive emotion regulation strategies, such as emotional suppression, and BPD-endogenous traits like attachment-seeking behavior can potentiate detrimental health outcomes through physiological correlates and medical self-harm. Future research directions should assess the role of emotional suppression in somatization and medical comorbidity in both sociodemographic and medically diverse BPD populations. In the clinical setting, encouraging reappraisal instead of emotional suppression can help improve treatment outcomes in both psychiatric and medical domains.
The screening of sleep disorders and obstructive sleep apnea syndrome should be performed routinely in many patients, particularly in high-risk populations. The aim of this study was to evaluate sleep disorders and the determinants of high risk of obstructive sleep apnea among diabetics. Methodology: This was a cross-sectional study which was conducted between March to August 2022 in state health structures in the Mopti region of Mali. This study included diabetic patients aged 18 and above who gave their consent to participate in the study. A standardized questionnaire containing both Berlin self-questionnaires was used for data collection. Results: A total of 289 patients participated in the study. The mean age was 51.59 ± 11.39 years. Among the participants, 66.9% were Type 2 diabetics, 70.9% were women. The body mass index average was 27.62 ± 4.26 kg/m2. The mean of sleep duration was 5.76 ± 1.43 hours per day. The majority of participants (92.4%) had high risk of obstructive sleep apnea syndrome. The variables statistically associated with the dependent variables (OSAS) were: high blood pressure (OR =52.4; 95% CI: [6.3 - 40.3]); non-smoking status (OR=0.04; 95% CI: [0.03 - 0.7]) and the body mass index ≥ 25 (OR=3; 95% CI: [3.1 - 14.9]). Conclusion: This study reveals a high frequency of sleep disorders among diabetics in the Mopti region. It would be necessary to conduct a national study to better estimate the prevalence of this pathology in order to implement effective control strategies.
Bangladesh’s population is ageing: adults 60+ now comprise ~9.28% of the population (≈15.76 million people), reflecting rapid gains in survival and healthcare, but exposing gaps in income security, health, and social inclusion. Community-based models—particularly ESDO’s Probeen Committees and Probeen Samajik Kendra—aim to restore dignity, participation, and access to services. Drawing on national statistics, policy reviews, and ESDO’s field experience, this paper (i) Situates ageing within current national trends and social protection architecture, (ii) Documents ESDO/PKSF interventions, (iii) Proposes a rigorous mixed-methods evaluation design, and (iv) Presents program results to date and an equity-focused coverage analysis. We conclude with policy directions to institutionalize community associations and recreation services as a core pillar of elder care in Bangladesh.
Bangladesh possesses a distinctive geographical position while being one of the hardest hit by climate change. The livelihood of a vast majority of Bangladeshis is jeopardized by various natural calamities on a regular basis. Women possess distinctive difficulties during any natural calamity. This study aimed to understand the correlation between gender, climate change, and vulnerability in Jamalpur district, Bangladesh. This study employed multi-method approach employing in-depth interviews with twenty women and five focus-group discussions. Findings revealed four vulnerability domains: (1) survival stresses—food, water and caregiving disruptions; (2) restricted resource access—land, credit and healthcare; (3) normative constraints on mobility and decision-making that heighten exposure to violence; and (4) institutional fragmentation that limits delivery of gender-responsive relief. Women are mostly vulnerable due to the lack of institutional facilities, social awareness, and the opportunity to have social services, financial accessibilities, and so on. Strengthening local disaster committees with female leadership, bundling climate-smart loans with training, and integrating early-warning, health and legal services could reposition women as frontline climate-resilience actors within district development planning and funding mechanisms. Abolishment of in equal gendered lenses, gendered sensitization of national and local policy and program implementation, etc. could be effective steps to reduce women's vulnerability.
The demographic transition consists of the substitution of slow population growth, achieved with high fertility and mortality rates, for sustained slow growth with relatively low fertility and mortality rates. Most nations follow remarkably similar evolutionary trajectories in the last 70 years. A universal demographic transition toward population aging is evident. Chile has shown an outstanding health situation in Latin America mostly due to the delivery of strong health services that had favored mortality and fertility declines. Specific measures are presented. At the beginning of the 20th century, the infant mortality rate (IMR) was very high and did not improve; between 1924 and 1936 it remained stable hovering around 220. It declined in close association with the expansion of public primary health care between 1937 and 1950. Births whose deliveries were attended by professionals reached universal coverage in 1990, associated with the foundation of the National Health Service in 1952. IMR in year 2024 is 6.2. Family planning policy began in 1966 aiming to reduce the high maternal mortality figure. Fertility has declined considerably: the fecundity rate was 5.4 children per woman in 1960-65 while in 1990-1995 reached a figure of 2.1. Moreover, in 2024 it has fallen to 1.03 children per woman, representing one of the lowest rates in the world. The last public policy that has attempted to increase fertility was begun in 2011: it increased maternity leave from 12 to 24 weeks postpartum. It has been associated with an increase in the duration of breastfeeding but has not been associated with an increase in fertility. Instead, the decline of the total fertility rate and the incorporation of women to the workforce were associated and deserves new social policies. The Chilean population is aging and new proposals to confront this situation are needed.
Prolonged grief disorder (PGD) is characterized with core manifestations of preoccupation and yearning, or both, which could be associated with emotional instability, disturbances in identity, loss of purpose and meaning in life, along with impairment in function. This commentary aims to elaborate these characteristics in the light of biological mechanisms, predisposing cardiovascular diseases (CVDs).The prevalence of PGD varies between 3.4% to 9.8% in various studies. People with bereavement or PGD are at heightened risk of CVDs, including acute myocardial infarction (AMI), heart failure, mortality, stroke, atrial fibrillation and psychological disorders such as depression. Prolonged grief can cause increased sympathetic activity with high stress hormones leading to oxidative stress and inflammation, that potentially affects coronary and heart muscle function. Intense grief may cause physical problems and may trigger AMI, in people with higher baseline risk of CVDs. PGD -induced chronic low-grade inflammation may predispose vasoconstriction, arrhythmias, increase in platelet aggregation, increased pro-inflammatory cytokines and release of endothelin with increased production of fibrinogen known to promote plaque destabilization and a pro-thrombotic state, with involvement of certain regions of the brain.
Background: Preventing healthcare-associated infections (HAIs) is essential for delivering safe and high-quality healthcare services. Globally, HAIs remain a significant public health concern, contributing to increased morbidity, mortality, and healthcare costs. Although many of these infections are preventable through cost-effective infection prevention and control (IPC) measures, healthcare facilities in sub-Saharan Africa often lack effective IPC programs. In Ethiopia, limited data exist on healthcare workers’ knowledge, attitudes, and practices (KAP) regarding infection prevention and patient safety. Objective: To assess the knowledge, attitude, and practice of infection prevention and patient safety among healthcare professionals in public health facilities in Asella town, Ethiopia, in 2025. Methods: A descriptive cross-sectional study was conducted from February 7 to March 20, 2025, among healthcare professionals working in Asella public health facilities. Participants were selected using simple random sampling. Data were collected using a standardized, pre-tested questionnaire. Ethical clearance was obtained from the Arsi University Ethics Committee, and formal permission was secured from the respective health facilities. Results: The study found that healthcare professionals’ knowledge of infection prevention was significantly associated with educational level (AOR = 3.248; 95% CI: 1.360–7.759), type of hospital (AOR = 0.304; 95% CI: 0.102–0.906), and the availability of bathing facilities (AOR = 0.101; 95% CI: 0.011–0.974). Conclusion: Educational level, hospital type, and the availability of bathing facilities are key factors influencing healthcare professionals’ knowledge and practices regarding infection prevention and patient safety. Strengthening IPC programs and addressing infrastructure gaps at the facility level may improve compliance and safety outcomes. Policy efforts should focus on institutionalizing regular IPC training and upgrading basic hygiene infrastructure across all public health facilities.
Most experts agree that education is an integral component of social justice and people should consider that social justice in health may depend on the social determinants of health. In a meta-analysis. The beneficial effect of education on reduction of all-cause adult deaths, has been reported. It is not clear, how education can provide benefits in reducing morbidity and mortality. Apart from general education, health education and motivation of the population, and learning as well as practice of health behavior are crucial. Prudent diet, moderate physical activity, moderation in alcohol intake, non-smoking, low mental stress, adequate sleep, as a public health policy at affordable cost are basic in the prevention of mortality due to CVDs and other chronic diseases. In this context the emphasis on mental and spiritual health, as part of culture, may be highly rewarding in the health education and motivation of the people on prevention of diseases and promotion of health.
This case report examines alcohol use disorder (AUD) in a 39-year-old urban Indian man with chronic alcohol consumption, hypertension, diabetes, and withdrawal symptoms, highlighting broader public health concerns. Alcohol use disorder (AUD) is a common public health problem in both developing and developed nations of the world. In India, historically, alcohol use has been an issue of great ambivalence throughout the subcontinent, with the most recent factors at play being colonial influences and state-specific policies (Sharma et al., 2010). In this case, urban stressors and weakened family support may contribute to problematic drinking, while family denial and limited access to treatment reflect potential barriers observed in urban settings. This case report explores AUD’s biological, psychological, and social dimensions in urban Indian men, contextualizing the case within historical, regional, and demographic data, and advocates for interventions like counseling and psychotherapy.
Background: Nigeria's public health sector development projects face significant supply chain challenges that critically hinder the efficiency and effectiveness of healthcare delivery. Objective: This study examined the supply chain challenges facing public health development projects in Nigeria by synthesizing existing literature to identify the current issues and structure, examining their impact on performance and implications for healthcare service delivery. Methods: A comprehensive literature search was conducted across multiple databases yielding a total of 14 relevant studies. Literature sources include academic journals, governmental and non-governmental organizations' reports, and health sector reviews. Results: The review revealed that Nigeria's public health supply chain is characterized by inadequate infrastructure, inefficient logistics, and governance and management issues. Poor road networks, insufficient storage facilities, corruption, insecurity, and delays in transportation were the major issues identified. Key organizations and programs such as the National Primary Health Care Development Agency (NPHCDA), National Malaria Control Program (NMCP), National Immunization Coverage Survey (NICS), Saving One Million Lives (SOML) initiative, and National Health Insurance Scheme (NHIS) play key roles but face lack of inter-organizational coordination and challenges. Conclusion: Inefficiencies in supply chains were observed to lead to frequent stockouts, poor program performance, and prolonged lead time for procurement. This narrative review highlights the critical need for supply chain strengthening in Nigeria's public health sector. This will require a multifaceted approach involving reforms in infrastructure development and stakeholder collaboration. By prioritizing supply chain improvement, Nigeria can enhance healthcare outcomes and achieve its health development goals.
This study presents a comparative assessment of the attitudes, perceptions, and the perceived impacts of the Central Bank of Nigeria’s (CBN) naira redesign and old currency swap policy among residents in Nigeria, with particular attention to gender differences and socio-demographic influences. Utilizing a descriptive research survey design, data were collected from 486 respondents-comprising 200 males and 286 females-across various socio-demographic backgrounds. The study was guided by four objectives: to examine and compare male and female attitudes toward the naira swap; to analyze gender-based differences in perception during the intense period of implementation; to assess the differential impacts of the policy on both genders; and to investigate the relationship between socio-demographic variables and the triad of attitude, perception, and Public Health Impact. Results revealed significant gender differences in attitudes toward the naira swap. Male respondents exhibited more favorable attitudes (Mean = 2.08, SD = 0.86) compared to females (Mean = 1.81, SD = 0.79), with a statistically significant difference (t = 4.23, p< 0.050). Perceptions of the policy, however, did not significantly differ by gender (t = -0.26, p>0.050), and both groups expressed general skepticism about the policy’s sustainability and effectiveness. Likewise, there was no significant gender difference in the perceived impact of the naira swap (t = 0.29, p = 0.77); both males (Mean = 2.82, SD =0.79) and females (Mean = 2.81, SD =0.79) reported substantial economic hardship, difficulty in accessing cash, and disruption of business activities due to the policy. Correlation analyses showed that attitudes were significantly associated with several socio-demographic variables: age (r = 0.18, p <0.050), gender (r = -0.19, p< 0.050), marital status (r = 0.12, p< 0.050), and family size (r = -0.09, p< 0.050). However, perception and impact of the policy were not significantly correlated with any socio-demographic variables, suggesting a relatively uniform experience and perception of the policy’s outcomes across different population segments. In conclusion, economic policy affects population outcomes and different socio-economic survival strategies such as cashless system, buying of new naira notes were reported in this study. While attitudes toward the naira swap policy varied significantly based on gender and personal characteristics, the perceptions and impacts were widely shared among residents. The findings highlight the need for evidence-based, inclusive and phased monetary policy implementation, with special consideration for gender dynamics, financial infrastructure readiness, and effective communication strategies to mitigate unintended socio-economic and public health consequences in future currency reforms in Nigeria.
Introduction: Psychiatric disorders are disorders that present a set of symptoms or behaviors associated with distress and interference with an individual's personal functions. They can affect anyone, across different age groups, genders, and races/ethnicities. These disorders include conditions such as anxiety, depression, alcohol and drug abuse, eating disorders, schizophrenia, and others. Approximately 1 billion people had one of these disorders in 2019, the majority of which were depression and anxiety disorders, which account for 60% of mental illness cases. These illnesses have been increasing in Brazil since 2019, posing a public health challenge. Objective: To study the epidemiological profile of mortality from mental and behavioral disorders in Brazil from 2014 to 2023. Methodology: A descriptive, quantitative, cross-sectional, time-series epidemiological study (2014-2023) was conducted using secondary data from the SUS Information System, TABNET-DATASUS, of the Ministry of Health - Brazil. Results: In the decade analyzed, there were n=151991 deaths from mental and behavioral disorders, with a mean of 15199,1 (±2780,78) and a Coefficient of Variation of 18.30%. Males were the most affected (n=107011), accounting for approximately 70%. White individuals had the highest number of deaths from these disorders, with n=68032 (45%), followed by brown individuals, with n=62352 (41% of the sample). Regarding education, deaths were more frequent in individuals with up to seven years of schooling (64%). Those over 30 years of age were much more affected by deaths from these disorders, totaling 146938 deaths. Final considerations: Mental and behavioral disorders should be a constant public health concern, as they imply a large number of deaths. Therefore, in Brazil, improvements in public health actions are necessary, aiming at prevention, early diagnosis and treatment of such disorders, in order to reduce the number of deaths related to these diseases.
Background: Adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs) continue to bear a disproportionate burden of new HIV infections, driven by structural, social, and behavioral vulnerabilities. Although oral pre-exposure prophylaxis (PrEP) is an effective biomedical prevention method, its uptake and continuation among AGYW remain suboptimal. This narrative review explores the effectiveness of peer-network interventions in improving PrEP uptake and continuation among AGYW at high risk of HIV in LMICs. Methods: A comprehensive search of PubMed, Embase and Google Scholar databases was conducted to identify peer-reviewed articles published between January 2010 and October 2024. Eligible studies involved AGYW aged 15–25, the studies were conducted in LMICs, and evaluated peer-based interventions with outcomes related to PrEP uptake, adherence, or continuation. Results: Eleven studies which met the inclusion criteria, spanning sub-Saharan African countries were selected from 1003 references. Peer-network strategies ranged from peer outreach and education to adherence clubs and behavior-centered social marketing. Initiation rates ranged from 28.1% to 95%, with significantly higher uptake reported in peer-supported interventions compared to standard approaches. However, continuation rates remained modest (<30%). Peer strategies were found to be acceptable and feasible, especially when integrated into youth-friendly settings, though challenges with sustainability and system integration persist. Conclusion: Peer-network interventions offer a promising approach to enhance PrEP uptake among AGYW in LMICs. However, sustained continuation will require multi-layered support, digital innovations, and integration into broader adolescent health platforms. Strategic investment in peer-led models could strengthen HIV prevention efforts and reduce incidence in this high-risk population.
Over the last century and a half, there has been a change in the epidemiological profile of causes of mortality in the world, particularly in developed countries. With a decline in infectious and parasitic diseases and an increase in chronic and degenerative diseases. This change in profile, however, has occurred unevenly in other developing countries, such as Brazil. These countries have shown only a slight change in their epidemiological profile. In addition to community-acquired communicable diseases, there is currently a major epidemiological impact of infectious diseases acquired in the hospital environment, known as healthcare associated infections (HAIs). In this scenario, this study seeks to identify epidemiological surveillance strategies for healthcare-related infections in the Brazilian healthcare system between 2018 and 2022. This is an integrative literature review, structured around the following stages: formulation of the research question; search and selection of primary studies; extraction of data from the selected studies; critical evaluation of the studies included in the integrative review; synthesis of the results and presentation of the review. In Brazil, all the studies show that there is a need to improve the operational guidelines and specific activities of the Hospital Infection Control Committees (HICC) in various services. The actions carried out by Hospital Infection Control Programs have varied in the literature, but these have offered suggestions for improvements for health managers in order to reduce the incidence of Healthcare-Related Infections.
Introduction: Viral hepatitis (VH) is a group of diseases frequently caused by five agents: hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E, with different epidemiological and clinical characteristics. Objective: To study the epidemiological profile of viral hepatitis in Brazil from 2014 to 2023. Methodology: epidemiological, cross-sectional, quantitative, descriptive, exploratory and time-series study, covering a decade, referring to the period from 2014 to 2023, carried out with secondary data from the Notifiable Diseases Information System (TABNET/DATASUS). The data were tabulated in Excel and presented in graphs and tables, absolute numbers and frequencies. Results: There was a total of n=353694 confirmed cases of viral hepatitis in Brazil in the decade from 2014 to 2023. The year with the highest peak was 2015, which presented 42563 confirmed cases. The Southeast region presented 45% of the cases, males were more affected and represented 56% of the sample. Regarding race, the white race predominated with 162206 cases. In Brazil, the age group of 40-59 years had the highest number of VH cases of 158050. About the VH criterion of confirmation, the criterion of laboratory confirmation of VH predominated with 351713 confirmed cases. As regards the mechanical source of infection, most confirmed cases were classified as Ignored/Blank (n=221607), followed by Sexual source (n=48049). Final Considerations: Viral hepatitis is still an epidemiological concern, although it has shown a decreasing trend in the decade under study, since after a decrease in 2020, a growing peak has resumed since then, currently remaining above the trend line.
Introduction: Dengue is caused by the DENV virus, which is a single-stranded RNA virus of the flaviviridae family, transmitted by Aedes vectors. There are four main serotypes of this virus: DENV-1, DENV-2, DENV-3 and DENV-4. This virus has impacted Global Public Health, especially the Eastern Mediterranean, Southeast Asia, Africa, the Western Pacific, and South America. In Brazil, the progression of the disease is a cause for constant concern and demonstrates a current growth trend. Methodology: An exploratory, cross-sectional and descriptive epidemiological study of time series (2015 to 2024) was carried out, with data from DATASUS - SUS Information System, of the Ministry of Health, Brazil. Results: There were n=161,22,017 reported cases of dengue in Brazil from 2015 to 2024, with an initial oscillating trend, but a continuous increasing trend since 2021, which peaked in 2024 (n=64,52,721) cases. More frequent in females with n=8838100 cases. The 20-39 age group had n=5828337 cases. The race was variable by region, being more frequent in the brown race in the Northeast, Midwest and North regions and more prevalent in the white race in the South and Southeast regions. The Unknown/white serotype was more prevalent. The unknown/white serotype was the most frequent (n=15839881), followed by DEN 1 (n=199796). Regarding the evolution, there was a predominance of unknown/white (n=3578656), followed by cure (n=12526508), deaths from dengue (n=12213) cases. Hospitalizations occurred in n=489729 reported cases of dengue. Final considerations: Dengue in Brazil is a highly worrying epidemic, the exorbitant number of cases presented in 2024, demonstrating a continuous growing trend since 2021, is something that raises a public health alert and demonstrates difficulties for the Brazilian health system in preventing this disease.
Introduction: Palliative care (PC) comprises health care that, through scientific means, dignity and compassion, provides a reduction in suffering in patients with serious, chronic or life-threatening health conditions, avoiding unnecessary interventions and improving quality of life. Primary Health Care plays an important role in addressing these conditions, especially outside the hospital environment and acting to prevent adverse outcomes. Objectives: This study aims to investigate the profile of palliative care patients in Primary Care in Brazil from 2015 to 2024. Methodology: A cross-sectional, quantitative, descriptive, exploratory and epidemiological study was carried out on the care of patients in palliative care, in primary care, in Brazil, from 2015-2024, with data from TABNET/DATASUS, Ministry of Health-Brazil. Results: Palliative care services in primary care numbered n=113076 appointments, the year with the highest number of appointments was 2024 with n=28827 appointments, the southeast region was the one that performed this procedure the most, representing 50% of the sample. Females represented the majority number of cases in Brazil, with n=57598, although in the North and Southeast regions males prevailed. Regarding the age group, 80 and over with n=29320 appointments. The elective nature had the greatest expressiveness of cases, totaling n=108286. Final considerations: Although most palliative care is provided in the hospital, primary health care has served a large number of patients in palliative care, although this hospital orientation may lead to difficulties in providing comprehensive care.
